Swimming-induced pulmonary edema: what it is and what to do if it occurs

Cardiac surgeon Lawrence Creswell explains what swimming-induced pulmonary edema/oedema (SIPE) is, and what you can do if you're prone to attacks when swimming

Credit: Remy Whiting

We’ve recently learned about swimming-induced pulmonary edema/oedema (SIPE), a condition that occurs in otherwise healthy individuals. For no obvious reason, and occurring only during immersion in water, fluid quickly builds up in the lungs, causing significant respiratory distress, perhaps with coughing, wheezing, or even coughing up blood. These symptoms usually improve when the victim stops swimming and gets out of the water. That’s the most important ‘treatment’.


Supportive care, with supplemental oxygen, may also be helpful. If victims get hospital care immediately after the episode, oxygen levels in the blood may be low and a chest x-ray may show fluid build-up in both lungs. These problems usually subside over several hours. It’s important to ascertain that there’s no alternative cause that may require treatment.

Risk factors for SIPE include high blood pressure, cold-water swimming, female gender, older age, and use of a wetsuit. SIPE can be unpredictable, though, and occur even in experiences swimmers.

For athletes who’ve experienced an episode of SIPE, you need to be aware that the problem may recur; rebuild up your confidence with short swims in the pool; don’t swim alone and never be too far from rescue or medical attention; avoid very cold water; avoid over-hydration; be sure high blood pressure is well-controlled; ask your doctor if a change in medication(s) may be helpful; and stop swimming at the first indication of breathing problems and get out of the water. 

Lawrence Creswell is a cardiac and thoracic surgeon with University of Mississippi Medical Center. Cardiac and thoracic surgeons specialise in the surgical treatment of diseases of the chest and heart.



How to spot and help someone in trouble when swimming

How to prevent motion sickness and nausea when swimming

Extreme exercise found not to increase risk of cardiovascular disease, say scientists

Swimmer’s shoulder: what causes it, and three exercises to treat it